Soil Quality Assessment in Farmland of a Rapidly Industrializing Area in the Yangtze Delta, China.

The comprehensive quality assessment of farmland soil is critical for agricultural production and soil ecological protection. Currently, there is no systematic method for conducting a comprehensive quality assessment of farmland soil; subsequently, as the most developed economic area in China, the comprehensive quality assessment of farmland soil in the Yangtze River Delta is lacking. We chose the farmland soil of Suzhou city as the research object. The soil fertility index (SFI) and soil environment index (SEI) were calculated with the membership function and Nemerow index. Finally, the comprehensive assessment of soil quality was achieved with the TOPSIS model. The results showed that the average values of soil pH, SOM, TN, AHN, AP, and AK were 6.44 (slightly acidic), 28.17 g/kg (medium), 1.63 g/kg (rich), 118.16 mg/kg (medium), 38.31 mg/kg (rich), and 160.63 mg/kg (rich), respectively. For the concentrations of heavy metals, including Cr, Ni, Cu, Zn, Cd, and Pb, in 122 soil samples, the percentages exceeding the background values of Jiangsu province were 5.74%, 8.20%, 8.20%, 10.66%, 86.07%, and 84.43%, respectively. Cd and Pb were the main heavy metal pollutants on farmlands. The soil samples with SFI values below the medium level (SFI < 0.6) accounted for 44.26%, and samples with SEI values below the medium level (SEI < 0.6) accounted for 13.12%. The values of the soil quality index (SQI) ranged from 0.171 to 0.996, with an average SQI value of 0.586 (very poor-V), and approximately half of the farmland soil quality in Suzhou city needed to be further improved. In a word, this study provides a theoretical basis and scientific support for the quality assessment and rational utilization of farmland soil.

Is Korean society prepared for the financial burden of novel anticancer drugs? A survey of willingness to pay among National Health Insurance beneficiaries.

PURPOSE: Since South Korea's 5-year policy of increasing National Health Insurance (NHI) coverage began in 2017, related pharmaceutical expenditures have increased by 41%. Thus, there is a critical need to examine society's willingness to pay (WTP) for increased premiums to include new anticancer drugs in NHI coverage. METHODS: Participants aged 20-65 were invited to a web-based online survey. The acceptable effectiveness threshold for a new anticancer drug to be included in NHI coverage and the WTP for an anticancer drug with modest effectiveness were determined by open-ended questions. RESULTS: A total of 1817 respondents completed the survey. Participants with a family history of cancer or a higher perceived risk of getting cancer had significantly higher WTPs (RR [relative risk] = 1.17 and 1.21, both P = 0.012). Participants who agreed on adding coverage for new anticancer drugs with a life gain of 3 months had a higher WTP (RR = 1.70, P < 0.0001). These associations were greater among the employed and low-income groups. The adjusted mean of acceptable effectiveness for a new anticancer drug was 21.5 months (interquartile range [IQR] = 19.3 to 24.0, median = 21.9). The WTP for a new anticancer drug with a life gain of 3 months was $5.2 (IQR = 4.0 to 6.0, median = 4.6). CONCLUSION: The unrealistic expectations in Korean society for new anticancer agents may provoke challenging issues of fairness and equity. Although Korean society is willing to accept premium increases, our data suggest that such increases would benefit only a small proportion of advanced cancer patients.

Quantitative Segmentation Analysis of the Radiological Changes by Using ITK-SNAP: Risk Assessment of the Severity and Recurrence of Medication-related Osteonecrosis of the Jaw.

Background and purpose: Medication-related osteonecrosis of the jaw (MRONJ) severely impairs patients' quality of life and is remarkably refractory to treatment. There are lots of studies about identification of the radiographic features of MRONJ, yet reports about quantitative radiographic analysis for the risk assessment of the severity and recurrence of MRONJ are rarely heard. The aim of this study was to investigate the volumes of osteolytic lesions and radiodensity values of osteosclerotic lesions in MRONJ patients by using ITK-SNAP for severity prediction and prognosis evaluation. Materials and methods: Of 78 MRONJ patients (78 lesions) involved in this retrospective study, 53 were presented as osteolytic lesions and 25 were presented as osteosclerotic changes alone. Comprehensive CBCT images, demographics and clinical data of patients were investigated. The volumetric analysis and radiodensity measurement were performed by ITK-SNAP. SPSS 25.0 were used for statistical analysis. Results: The osteolytic lesion volumes in MRONJ patients receiving intravenous bisphosphonates (P=0.004) and patients without osteoporosis (P=0.027) were significantly large. No significant correlation between the volumes and bisphosphonates duration was found (P=0.094). The radiodensity values of osteosclerotic lesions was significantly correlated with bisphosphonates duration (P=0.040). The surrounding area of post-surgical lesions in MRONJ patients with recurrence showed significantly great radiodensity values (P=0.025). No significant correlation between the radiodensity values and the transformation from osteosclerotic lesions to osteolytic lesions was observed (P=0.507). Conclusion: MRONJ patients receiving intravenous bisphosphonates develop into large volumes of osteolytic lesions more easily. Long-term bisphosphonates duration is possibly related with higher bone density of osteosclerotic lesions, while higher density is not associated with the transformation from osteosclerotic lesions to osteolytic lesions. A rise of bone mineral density nearby post-surgical lesions is probably a predictor for MRONJ recurrence.

The impact of depressive symptoms on health value in patients with gynecologic cancer: A comparison with physical symptoms and performance status.

OBJECTIVE: The importance of managing depressive symptoms is frequently underestimated in the clinic. In this study, the effects of depressive symptoms on health utility value (HUV) in gynecologic cancer patients are evaluated. In addition, the effects were compared with those of performance status and physical symptoms. METHODS: Patient-reported outcome data from 274 gynecologic cancer patients were prospectively collected. HUV was measured using the 3-level version of the EuroQoL 5-dimension descriptive system (EQ-5D-3L) and the EuroQoL visual analog scale (EQ-VAS). The Patient Health Questionnaire-9 (PHQ-9) was used to measure the severity of depressive symptoms. The impact of depressive symptoms on HUV was analyzed using the generalized linear model. RESULTS: Moderate-severe depressive symptoms were significantly associated with a decrease in HUV in gynecologic cancer patients (p < 0.0001 for the EQ-5D-3L and EQ-VAS). Severe fatigue and severe pain were also associated with a decrease in HUV (p = 0.018 and p < 0.0001 for the EQ-5D-3L and EQ-VAS; p < 0.0001 for the EQ-5D-3L, respectively), and the effect sizes were comparable to that of moderate-severe depressive symptoms. In addition to the patients with moderate-severe depressive symptoms, the patients with mild depressive symptoms also experienced a significant decrease in HUV (p < 0.0001 for the EQ-5D-3L and EQ-VAS). The effect size for mild depressive symptoms was comparable to those for mild fatigue or mild pain. CONCLUSIONS: Even mild depressive symptoms may significantly compromise HUV in gynecologic cancer patients, and the effect is comparable to that of performance status or physical symptoms. Gynecologic oncologists should put more effort into properly preventing, detecting, and managing depressive symptoms.

[Quality Assessment of Euglycemic Glucose Clamp Test].

OBJECTIVE: To explorethe quality of euglycemic glucose clamptest performed in the West China Hospital from 2014 to 2017 and to evaluate whether the quality control indexes are suitable for the quality assessment of the clamp test. METHODS: The data collected from 80 euglycemic glucose clamp tests performed between 2014 and2017 were divided into 4 groups according to the coefficient of variation of the blood glucose concentrations (CVBG): group A (CVBG≤4.5%), group B (4.5% < CVBG≤5.0%), group C (5.0% < CVBG≤5.5%) and group D(CVBG > 5.5%).The differences in percentage of glucose excursion from target range (GEFTR), the duration of GEFTR, the area under curve (AUC) of GEFTR, the mean value of excursion from target glucose (GEFT) and the AUC of GEFT were calculated and compared. RESULTS: In group A, the mean value of CVBG was 3.75%. In group B, the mean value of CVBG was 4.76%. In group C, the mean value of CVBG was 5.28%. The median value of CVBG in group D was 6.07%. The percentage of GEFTR, the duration of GEFTR, the AUC of GEFTR, the mean value of GEFT and the AUC of GEFT in group A were all less than those of other groups (P < 0.05).For the same indexes, there were no significant differences between group B and C, while they were higher in group D compared with the other three groups. CVBG was positively correlated with other quality control indexes (correlation coefficient r was 0.770-0.805). Based on the cut-off point 5% of CVBG, the cut-off points of the percentage of GEFTR, the duration of GEFTR, the AUC of GEFTR, the mean value of GEFT and the AUC of GEFT were 5.8%, 14.6 min, 22.82 mg/dL×min, 3.23 mg/dL, 216.25 mg/dL×min/h respectively, with the sensitivity range from 79.3% to 100% and the specificity range from 74.5% to 89.7%.Combined with these indexes, 8.11% of euglycemic clamps were found to havepoor quality in group A, while 66.67% of euglycemic clamps showed acceptable quality in group C. CONCLUSIONS: The investigators should provide an estimation of the quality of the clamps when reporting the results of the insulin analogues' PK/PD characteristics using euglycemic clamps. CVBG less than 4.5% indicates a good quality, and the above-mentioned quality control indexes especially the AUC of GEFT(cut-off point: 216.25 mg·/dL×min/h) should be evaluated when CVBG is more than 4.5%.False high quality and false low quality euglycemic clamps will be detected and a more precise estimation of quality assessment should be made by the combination of these indexes.

Incidence and costs of cervical intraepithelial neoplasia in the Korean population.

OBJECTIVE: The purpose of this study was to assess the incidence rate of cervical intraepithelial neoplasia (CIN) and cervical cancer, and their costs according to age. METHODS: We collected data on annual incidence and medical costs of CIN and cervical cancer from 2010 until the end of 2014 from the Health Insurance Review and Assessment (HIRA) service. The CIN was classified into CIN3 (high-grade) requiring conization and CIN1/2 (low-grade) requiring observation. RESULTS: Incidence rates of CIN3 and cervical cancer are reducing over time, whereas CIN1/2 is increasing significantly (p for trend: <0.001). The peak ages of incidence were 25-29, 30-34, and 70-74 years old for CIN1/2, CIN3, and cervical cancer, respectively. The crude incidence of CIN1/2 increased by approximately 30% in 2014 compared to 5 years ago and demonstrated an increasing trend in all age groups. The CIN3 showed a significantly increasing trend in the age group of 30-39 years old, the cervical cancer was significantly reduced in all ages, except the 35-39 years old. The treatment for cervical cancer costs $3,342 per year, whereas the treatment for CIN3 and CIN1/2 cost $467 and $83, respectively. CONCLUSION: The crude incidence rate of cervical cancer is currently decreasing among Korean women, but the incidence rates and medical costs of CIN and cervical cancer are increasing in women in their 30s in Korea. These findings suggest that different strategies by age will be required for prevention of cervical cancer in Korea.